Wednesday, January 18, 2012

Art Show!?

I hope Sunshine's SLP knows how lucky she is.

I made the huge mistake this morning, at 8am, of telling Sunshine that her SLP, Michelle, would be here today. What I didn't tell her, as she's only 2 and has no way of understanding, is that M wouldn't be here until 1045am, so instead of thoughtfully giving my child a preview of her day, I caused endless stress and anxiety, because, no, she's not here yet.

"Artshow?" It only took an hour to figure out that she didn't mean she wanted to watch Yo Gabba Gabba's "Art Show" episode, which she did get to watch because "artshow" only sounds like "Michelle" if you're a really drunk, which I was not.

"Ohhhhh! Michelle?! You want Michelle?!"
(This is a Big Deal, as she doesn't really ask for anyone, ever.)
"Artshow! Toys!"
"Yes, Michelle brings toys to play with you!"
"Elmos!" (She gets plurals. It's really cute.)
"Yep, she'll have Elmos for you to play with!"
"Yes! Michelle will bring puzzles!"
"Umm-hmm. Michelle is coming to play with you!"
"Yes, Michelle is coming to play with Sunshine. Very good."
"Fah? Floor! Yes, Sunshine and Michelle are going to play on the floor!"
Lather, rinse, repeat, for nearly three hours.

Michelle came and went. Sunshine played very happily, and only shut down for a tiny bit about halfway through the hour. She really doesn't like being pushed to talk. It's only her third session, but she's starting to grow bored of the toys already, and is getting a little resistant to constantly having to "put your lips together!" to produce p/b/m sounds.

She has p/b/m, which are very early sounds, but only in certain contexts. She can say "mama," "poop," and "boo-boo" as clear as a bell, but whenever there's a long a, e, or i after the p/b/m, she usually switches to a d/g/k sound, but sometimes to a "shu" or other sound. So "pee-pee" is "kee-kee," "baby" is (currently- "baby" changes a *lot*- it was "ashee" for the longest time) "aye-kee," and "me" is "nee."

*I* suspect apraxia, which is why we got the neurology referral. I mean, my doctorate is from Google U, so I have no idea what I'm talking about 99% of the time, but from what I can see, she has a lot of red flags for childhood apraxia of speech. In a nutshell, CAS is neurologically based- the brain knows what it wants to say but can't correctly tell the mouth what to do. It's a motor-planning problem, kind of like dyslexia of the mouth area. (There exist both oral apraxia and apraxia of speech- usually you can have just verbal apraxia and not oral, but if you have oral, you almost always have verbal apraxia, too.) See, my kid's so special and perfect that she can't *possibly* just have a general speech issue; she has to have a fancy rare thing, because she is such a special, unique snowflake. Yes, you can all roll your eyes in my general direction. I'm pretty insufferable.

She was a late babbler, and was never chatty once she started- "quiet baby" is an understatement for her infancy. She often says words seemingly inside-out: "dada" first was "ahda," and "flower" was "uhfuh." She has really inconsistent consonants and vowels- "nose" is anything from "nose" to "news" to "nuhse," all in the same day, and car will be anything from "cah" to "fah," to, as it is today, "fuhm." She can't imitate facial expressions, lick her lips, pucker her lips, puff her cheeks, wiggle her tongue, or bite her lip (though these could all be due to oral-motor weakness, which is different than motor-planning.) She had a lousy latch all through her 11.5 months of breastfeeding and only just learned to drink from a straw last week. She has very limited facial expressions in general. She pauses a lot between words, and her pronunciations break down dramatically when she tries to string more and/or longer words together. The phrases she has solid, like "all done," or "it's okay," come out quickly and smoothly, but newer phrases are very stilted. "Mama. (pause) Help. (pause) Sunshine." She's still really echoy, and new things she overhears and repeats tend to come out clearly, but when she uses them again on her own, they're often muddled.

Michelle thinks it's more of a motor weakness issue, so we did a really half-assed little test to see if she'd allow us to bribe her into making some nice mouth movements. Nope. She wanted that lollipop alright, but still couldn't pucker her lips, lick her lips, or wiggle her tongue. It wasn't surprising, but it wasn't terribly good science. Sunshine drools a little bit more than she should at her age, and has an open bite, probably due to her heavy pacifier use at bedtime and naps. Those things are usually more indicative of motor weakness than motor planning, but, my Google U degree and $5 will get me a cup of coffee.

We really don't know what's causing her speech issues. It could be any number of things, and it could very easily be something that we'll never know. Artshow will need to spend more sessions with her to see what works and what doesn't. She's already picked up on the lack of face-checking Sunshine does, and has adjusted her play style accordingly, bringing desired toys up to her mouth to get Sunshine to look at the way her mouth is shaped.

Aaanyhow, she gets fed up working those bilabial sounds (b/p/m, for those of you just joining us) and quits quickly when she's asked to say a CV (consonant-vowel) combo that she doesn't have. "Ba-ba-boo" is fine. She'll say that all day. "Ba-ba-bee" is met with a very firm "ALL DONE."

Overall, she's doing great, though. She's cheerful, cooperative, and tries very hard. Artshow says she's at the top of her caseload in terms of overall speech, though, which is wonderful. I mean, someone's got the kid who isn't doing well, and as dickish as it is, I'm glad it's not me.

So Sunshine enjoyed her 60 minutes with Artshow today, and I thought that would be the end of it. But, no. She woke up from her nap asking for Artshow, with her precious Elmos and Pig and Pegs ("Elmos," "Tig," and "Tigs," of course.) By bedtime, she would ask for Michelle, then pause, and you could see the little lightbulb start to glow- "keek!"

"Yes, Michelle will be here next week."



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